Vitamin D-Related Risk Factors for Maternal Morbidity and Mortality during Pregnancy: Systematic Review and Meta-Analysis

Abstract

Vitamin D deficiency (serum 25-hydroxyvitamin D [25(OH)D] levels <20 ng/mL in serum) is a common health condition among pregnant women, especially in high-risk groups. Evidence has connected vitamin D levels with many health-related problems during pregnancy, including gestational diabetes and preeclampsia. Because of vitamin D’s effect on both mother and fetus, we systematically review the association between 25(OH)D level and its health effects. From a total of 143 studies, 43 came from PubMed, 4 from Cochrane, and 96 from EMBASE. After screening, we identified 38 studies as candidates for inclusion. Ultimately, we limited this review to 23 articles originating from 12 countries, written in English or Spanish, and conducted between 2010 and 2022. We conducted this review according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and evaluated the quality and strength of the evidence by using the Navigation Guide Systematic Review Methodology (SING). These systematic reviews summarize findings that support vitamin D’s role in reducing risks of multiple outcomes and the possible contribution of adequate vitamin D levels to a healthy pregnancy.

Guidelines for Preventing and Treating Vitamin D Deficiency: A 2023 Update in Poland

“…Vitamin D is very important during pregnancy and lactation. Higher 25(OH)D concentrations are associated with a reduced risk of Cesarean delivery, gestational diabetes, pre-eclampsia, and preterm delivery [ 68 , 69 , 70 ]. Optimal 25(OH)D concentrations during pregnancy are over 30 ng/mL (75 nmol/L).…”

Evidence That Increasing Serum 25(OH)D Concentrations to 30 ng/mL in the Kingdom of Saudi Arabia and the United Arab Emirates Could Greatly Improve Health Outcomes

“…However, as we now understand, most vitamin D RCTs conducted to date have been inappropriately designed, conducted, and analyzed [ 33 , 196 ], so that lack of support from earlier RCTs where, for example, achieved vitamin D status was not examined should not be a major concern since the peer-reviewed literature does provide good evidence for promotion of reproductive health by adequate vitamin D status. This includes that vitamin D may improve fertility for both males and females [ 197 , 198 ], that vitamin D promotes normal development of the fetus by ensuring the necessary epigenetic changes take place [ 199 , 200 ] that vitamin D reduces the risk of preterm birth, of small for gestational age births and of stillbirth as well as of pre-eclampsia with its associated increase in maternal and neonatal risks [ 201 ], that vitamin D reduces maternal morbidity and mortality [ 202 , 203 ], and reduces the risks of gestational diabetes [ 204 ]. Intact (unprocessed) vitamin D is needed by nursing infants [ 205 ] and repletion by the time of birth avoids the risks of neonatal hypocalcaemic status epilepticus [ 206 ] and of hypocalcaemic cardiomyopathy [ 207 ] both of which have high mortality rates unless they are correctly diagnosed and treated very rapidly.…”

Hypomineralization disorder in tropical Southeast Asia during the agricultural revolution: Analysis of morbidity and mortality

“…Additionally, the presence of these deficiencies marks unseen systemic effects on the individual's organ and cognitive function, immuno‐sufficiency to cancers and infectious diseases, normal endocrine function, growth and development, and musculoskeletal development (Snoddy et al, 2016; Vlok, Snoddy, et al, 2023). Where multitudes of individuals within an assemblage present skeletal evidence for hypomineralization disorder, a population burden on economic and domestic production of food and resources, cognitive impacts on decision making in changing environments, high infant and maternal mortality, and high burdens of care related to disabled and sick individuals can therefore be inferred (Arshad et al, 2022; Grant et al, 2009; Morales‐Suárez‐Varela et al, 2022; Snoddy et al, 2016; Zittermann et al, 2009).…”